Programme evaluation of a geriatric rehabilitation day hospital

Abstract

Objective: To evaluate the rehabilitation programme in a geriatric day hospital.

Design: An observational study.

Setting: An urban geriatric rehabilitation day hospital.

Subjects: Three hundred and fifty-three older patients admitted to a rehabilitation day hospital during 2000: 163 post stroke, 113 with deconditioning and 77 post orthopaedic surgery (hip fracture and joint replacement).

Main outcome measures: Functional Independence Measure (FIM), Nottingham Extended ADL Index, timed 'get up and go' test.

Results: The mean discharge scores of all FIM items were significantly higher than the mean admission scores. Mean score change, however, for each item was less than one point. Most of the patients (70%) improved by less than 5 points, regardless of main admission diagnoses. Patients with a lower admission FIM score improved more than those with a higher admission score. The majority of the enrolled patients (92%) showed an improvement in their Nottingham Extended ADL Index score. The mean (SD) score on admission was 21 (11.9) and at discharge 31 (14.6). In all but three items (self-feeding, using a telephone and driving a car), mean scores at discharge were significantly higher than admission scores (p < 0.001). A significant improvement in timed 'get up and go' score was found for all patients regardless of main diagnosis. Performance time decreased by 33% and discharge scores for all patient groups were approximately 20 seconds.

Conclusions: The notable improvement in mobility and instrumental activities of daily living on the one hand, and the minor improvements achieved in basic activities of daily living on the other, suggests a need to revise treatment goals of day hospitals.